The travel payments data contains reimbursements for particular travel events (TVLAMT). Each observation in the SAS and SQL data has an accompanying vendor ID. This component allows the site access to Communications, Configuration and Reporting options for FBCS. Any variable that has an S prefix indicates secure data and requires special permission to access; researchers should be aware of this when submitting their IRB applications and their CDW DART data access requests. For care received under the Choice Act, Veterans will work with the third party administrators of the Choice program to find an eligible provider in their area.4. Inpatient procedures are captured by ICD-9 procedure codes (SURG9CD1-SURG9CD25) in the hospital claims file. The funds are used to provide the best care possible to our Veterans. Thus, in SQL the total cost of an inpatient stay would be determined by evaluating the DisbursedAmount in the [Fee]. Accessed October 27, 2015. At the time of writing, no National Institute of Standards and Technology (NIST) vulnerabilities had been reported and no VA Cyber Security Operations Center (CSOC) bulletins had been issued for the latest versions of this technology. The SAS PHARVEN dataset contains information only about pharmacy vendors. VA Technical Reference Model - DigitalVA This component provides a front end for scanning claim forms into a temporary image queue for a given patient. MDCAREID is available in most inpatient SAS Fee Basis records. We compared the service date (TREATDTO in inpatient and ancillary, TREATDT in outpatient, and FILLDTE in pharmacy files) to the FMS processing date (PROCDTE) (See Table 1). To link an authorization to a claim, use the trifecta of what VistA would consider sta3n, PatientIEN, and AuthorizationIEN. have hearing loss. Mailing Address for Disability Compensation Claims - Veterans Affairs If disbursed amount is missing (but not $0), use payment amount instead. Thus the variable INTIND (interest indicator) equals 1 if the claim is eligible for interest and 0 otherwise. Fee Basis providers vary in how frequently they submit an invoice for Fee Basis care. Patient residence related geographic information is available in the [Patient]. Veterans Health Administration. Claims for Non-VA Emergency Care The vendor represents the entity billing for the non-VA care, while the provider represents the person who was involved in care provision. Each table has only one primary key field. Dental claims must be filed via 837 EDI transaction or using the most current. A claim for which the Veteran had coverage by a health plan as defined in statute. Accessed October 16, 2015. 1725 or 38 U.S.C. Many variables in the Fee Basis files record details of invoice and check processing. This application completes the update of critical claims data into the FBCS shared MS SQL database for further processing and reporting. Patient identifiers are also different across SAS and SQL data. When a claim is linked to VistA, the variable Other_Hlth_ins_present is populated. In the Fee Basis inpatient data, each record represents a separate claim; these separate claims must be aggregated to capture the totality of the inpatient stay. If you are submitting a paper claim, please review the Filing Paper Claims section below for paper claim requirements. However, the VA may pay a rate higher than the Medicare Fee Schedule rate for care provided in highly rural areas, as long as this rate is determined to be fair and reasonable by VA. One can find more information on payment rates under the Veterans Choice Act in federal regulation 17.1500. All tablesmentioned in the Fee Basis guidebookare storedin an Excel file. Researchers can look at the disposition variable as an indicator of transfer between VA and non-VA care. For emergency care of service connected conditions, there is a two-year limit to submit any bills. If electronic capability is not available, providers can submit claims by mail or secure fax. U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. As of April 2019, this guidebook is no longer being updated. For example, the meaning of DRG001 is not the same in FY05 vs FY15. 1. For more information call 1-800-396-7929.Claims for Non-VA Emergency CareVeterans need to make sure any bills for non-VA emergency care of non-service connected conditions are submitted to the VA Medical Centers NVCC Office within 90 days. VAntage Point. Unauthorized care can be of an inpatient or outpatient nature. 9.2. Researchers who have never before used CDW are encouraged to read the VA CDW First Time Users guide, available from the VIReC website (VAintranet only:http://vaww.virec.research.va.gov/CDW/Overview.htm). Contact the VA North Texas Health Care System. Community providers should remain in contact with the referring VA Medical Center to ensure proper care coordination. Attention A T users. Payment for care provided under the Veterans Choice Act may not exceed the Medicare Fee Schedule (i.e. In both SAS and SQL, it can be difficult to determine the provider the Veteran saw for Fee Basis care. Journal of Rehabilitation Research and Development. These clams contain charges and are known as claimed amounts (PAMTCL in SAS, ClaimedAmount in SQL). Some web reports contain PHI and access to these is restricted. This amounts to approximately 1.7 million claims processed per month and approximately $5-8 billion per year. Steps to collapse records into a single inpatient stay: 1. Those options are: Utilize HealthShare Referral Manager (HSRM) for referrals, authorizations and documentation exchange. The zip code accompanying the VEN13 variable denotes the zip code to which VA sent reimbursement, not the zip code where the service was rendered. There are five forms of patient identifiers in SQL files at CDW (including but not limited to the Fee Basis files): PatientICN, PatientSID, PatientSSN, ScrSSN, and PatientIEN. Technologies must be operated and maintained in accordance with Federal and Department security and For example, an interest payment of $14.21 would appear as 1421. INTAMT is part of DISAMT; it should not be added to them. [ICDProcedure] table through the ICDProcedureSID. Beware of VISNS 4, 15, and 23, as they have their own integrated system. By store procedure codes as records in another table, the SQL relational database uses the minimum amount of storable space. SAS and SQL contain different variables to identify the provider and/or vendor associated with the care. There are 34 Fee Basis Claims Systems (FBCS) servers, which were originally designed for episodes of care. Mail to: DEPARTMENT OF VETERANS AFFAIRS. If billing electronically, please include "Other Payers Information" in Loop 2320, 2330A, 2330B, and 2430. Persons interested in studying care provided under the Choice Act may wish to explore the VACAA tables or the FBCS tables at VA Corporate Data Warehouse (CDW). This technology can use a VA-preferred database. To access the menus on this page please perform the following steps. Second, there are some cases where the disbursed amount is $0, while the payment amount is greater than $0; these are cases in which the payment was cancelled and the true cost of care is thus $0. 1725 (the Mill Bill) by enabling VA to pay for or reimburse Veterans enrolled in VA health care for the remaining cost of emergency care if the liability insurance only covered part of the cost. The same concept (such as fiscal year, state, or county) may be represented by several variables, sometimes in differing formats. Much Fee Basis care is pre-authorized prior to the Veteran obtaining care and is thus considered Authorized Care. VA Information Resource Center. Additional information on accessing the AITC mainframe is available on the VHA Data Portal (VA intranet only: http://vaww.vhadataportal.med.va.gov/Home.aspx). Data Quality Analysis Team. Users interested in learning the rules in force at a particular point in time should contact the VHA Office of Community Care. Both ancillary and outpatient files have one record per CPT code. For education claims, refer to the appropriate Regional Processing Office. The deadline for claims submission is dependent upon which program the care has been authorized through or which program the emergency care will be considered under. (refer to the Category tab under Runtime Dependencies), Users must ensure that Microsoft Structured Query Language (SQL) Server, Microsoft Internet Explorer (IE), and Microsoft Excel are implemented with VA-approved baselines. URLs are not live because they are VA intranet only. (1) A Veteran must be enrolled in VA health care16. JANESVILLE, WI 53547-4444. or Fax to: TOLL FREE: 844-531-7818 & 248-524-4260 (Utilized for Foreign Claimants) return to top. CDW Data Quality Analysis Team has particular recommendations for excluding observations before beginning analyses on your cohort.13 Corporate Data Warehouse (CDW) contains dummy data as well as test patients that will need to be removed from tables before conducting analyses. Any supporting documentation that VA is unable to link to a claim will be returned to sender to for additional information. DSS Fee Basis Claims Systems (FBCS) - oit.va.gov We detail differences amongst the SAS and SQL Fee Basis data in the guidebook below. Assistance with claims is free and covers all state and federal veterans' programs. U.S. Department of Veterans Affairs. Optum is a proud partner with the VA through its Community Care Network (CCN). This is in line with the way VHA Office of Productivity, Efficiency & Staffing (OPES) ascertains ED visit. Appendix E includes a list of SQL fields related to the type of care a patient receives. Health plans include private health insurance, Medicare, Medicaid, and other forms of insurance that will pay for medical treatment arising from the patients injury or illness (e.g., automobile insurance following a car accident). In this situation, a given VA medical center has a preferred hospital from which it purchases care. one setting of care (inpatient or outpatient). 400, Wittman Drive Grand Rapids Itasca County MN - 55744 United States. Fee Basis Services - VetsFirst We gratefully acknowledge comments and contributions from Sharon Dally, Susan Schmitt and Paul Barnett. Accessed October 16, 2015. The UB-92 equivalent variables would be: facility (after merging in facility name from the FBCS_Facilities table), vistapatkey, and vistaauthkey, respectively. Each year represents the year in which the claim was processed, not the year in which the service was rendered. Office of Accountability & Whistleblower Protection, Training - Exposure - Experience (TEE) Tournament, New York/New Jersey VA Health Care Network, Call TTY if you Government contractor DSS Inc a new plan to fix VA's failing non-VA fee basis claims processing and management system with certain software updates - self-funded - to improve the system. Compare the discharge date of the first observation to the admission date of the next (second) observation. Here, ICDProcedureSID is a primary key in the [Dim]. Care provided in foreign countries other than the Philippines. They could form part of an overall strategy to locate care provided in specialized settings, such as state homes, or of specialized services like kidney dialysis. Seven refer explicitly to Veterans alone, while the remaining two are for diagnostic services or eligibility exams, neither of which constitutes treatment. Unauthorized Care is that which was not pre-authorized but was still reimbursed, such as emergency care. 6. Note that some physicians use the same ID number as the hospital. Thus, our recommendation is as follows: Use disbursed amount to calculate the cost of care, except in the case where disbursed amount is missing and the payment was not cancelled. The travel payment data contains reimbursements for particular travel events (TravelAmount). The prescriptions filled by fee-basis pharmacies are often small quantities of medication to meet the patients emergency or short-term needs while a CMOP prescription is being filled. You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links. The process for filing a claim for services rendered to a Veteran in the community varies depending upon whether or not the services were referred by VA and by the entity through which the services were authorizedVA or one of the VA Third Party Administrators (TriWest Healthcare Alliance or Optum United Health Care). NNPO. Unlike the inpatient data, there can be multiple records with the same invoice number. Given these delays in processing claims, we recommend that analyses use Fee Basis data from 2 years prior to the current date to ensure almost complete capture of inpatient, ancillary and outpatient data. More information on the proper use of the TRM can be found on the Please visit Emergency Care Claims to learn more. Using SQL data will allow the researcher to link to other rich data found in CDW, such as the Health Factors data. 3. VA can waive the deductible in hardship cases. Training - Exposure - Experience (TEE) Tournament. Your monthly premium for Part B may go up 10% for each full 12-month period that you could have had Part B, but didn't sign up for it. FBCS is moving to a centralized system in the near future, where there will be centralized rules and national policies with 3 distinct groups: CCN (network), CCRA (authorization), and CCRS (reimbursement system; an IBM product). With few exceptions these variables will be of little interest to researchers. Veterans Affairs (VA) users must ensure VA sensitive data is properly protected in compliance with all VA regulations. Some Non-VA Medical Care claims are rejected for untimeliness or lack of statutory authority. The Florida Department of Veterans' Affairs has Claims Examiners co-located with the VA Regional Office in Bay Pines, each VA Medical Center and many VA Outpatient Clinics. 14. Coverage will start July 1 of that year. For more information, please visit the Data Access Request Tracker (DART) Request Process page on the VHA Data Portal(VA intranet only: http://vaww.vhadataportal.med.va.gov/DataAccess/DARTRequestProcess.aspx#resources). Important: The mailing address below only pertains to disability compensation claims. To enter and activate the submenu links, hit the down arrow. If there are multiple providers using the same entity to bill their claims, it will not be possible to disaggregate what type of provider the patient saw (e.g., an internal medicine physician or an infectious disease specialist). Below are some answers to general questions about the FBCS tables. This research was supported by the Health Services Research and Development Service, U.S. Department of Veterans Affairs (ECN 99017-1). VA Health Care: Management and Oversight of Fee Basis Care Need 4. Again, date of service is not available in the FeeServiceProvided table. One can evaluate which encounters were unauthorized by joining the FeeUnauthorizedClaim table through the FeeUnauthorizedClaimSID key. If the gap is 0 or 1, evaluate the discharge date of the first and second observation. Data in any of the any S tables require Staff Real SSN access. VA-station related information includes STA3N, STA6A and STANUM in SAS and Sta3n and PrimaryServiceInstitution in SQL. The FMS disbursed amount is the payment amount plus any interest payment. The invoice table would have to have a sufficient number of fields to accommodate the maximum number of procedures report on any invoice. VA is required by law to bill private health insurance carriers for medical care, supplies and prescriptions provided for treatment of Veterans' nonservice-connected conditions. These clams contain charges and are known as claimed amounts (PAMTCL in SAS, ClaimedAmount in SQL). VA Information Resource Center VHA Corporate Data Warehouse [webpage]. Fee Basis Services. Information from this system resides on and transmits through computer systems and networks funded by the VA. You can find more information about eligibility on the VHA Office of Community Care website. [Patient], [Spatient]. Inpatient care, regardless of patients health status, if VA was not notified within 72 hours of admission. In FY05, DRG001 means CRANIOTOMY- >17 W CC, compared to HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM W MCC for DRG001 in FY15 DRG001. Updated August 26, 2015. This latter table contains a variable called InitialTreatmentDateTime. Updated September 21, 2015. All Fee Basis care will be found in the Fee files. There may be multiple vendor IDs (VENDIDs) for a single inpatient stay. Many classes of Veterans are eligible for travel payments. Access; upload; download; change; or delete information on this system; Otherwise misuse this system are strictly prohibited. HERC: Fee Basis Data: A Guide for Researchers - Veterans Affairs However, in all data files, the vast majority of observations are missing values for this variable. The Department of Veterans Affairs (VA) often pays providers in the community to provide care to Veterans when it is unable to provide such care itself (e.g., due to a lack of resources or delays in providing care), or when it is infeasible to do so (e.g., emergency care). HERC: Fee Basis Data: A Guide for Researchers - Veterans Affairs HERC researchers found that claims for the professional component of hospital stays also appeared in the file of claims for outpatient services. visit VeteransCrisisLine.net for more resources. Class 2 or Class 3 products must restrict their interfaces to Class 1 National Software to use of publicly-supported APIs ONLY. VA HEALTH CARE Management and Oversight of Fee Basis Care Need. E-fax: Documentation sent via email to Veterans Affairs Medical Center (VAMC) fax machine. Researchers should pay special attention to reducing duplicates in the pre-2008 data. In SAS data, there is also a primary service area variable (HOMEPSA) that indicates the station to which the Veterans residence is assigned based on geography. This improves our claims processing efficiency. Records that relate PatientSID to PatientICN are found two tables: Patient.Patient and SPatient.Spatient. Many URLs are not live because they are VA intranet only. Those with access to the VA intranet can find a list of SQL fields on the CDW MetaData site. Edward J. Hines, Jr. VA Hospital, Hines, Ill. 2007. VA will arrange for transportation for them or will reimburse expenses on the basis of vouchers submitted. Veteran's ICN can be found on the VA issued HSRM referral. A claims scrubber software program is run to ensure completeness and to locate possible errors. Claims should be mailed to the following address: VA Eastern Kansas Health Care System Attn: Fee Basis Office 2200 SW Gage Blvd Topeka. 2. Multiple SAS datasets have VENID and VEN13N. Fee Basis: 214-857-1397 C & P. VA Claims Representation; RESOURCES. We give an example here that relates to FeeInpatInvoice table. Below we describe the general types of information in both the SAS and SQL data. For example, a technology approved with a decision for 7.x would cover any version of 7. SAS data are also available in CDW, but are currently limited to those VA employees with operational access. PMS-DRG was effective in FY 2008; prior to this time CMS-DRGs were used. See 38 USC 1725 and 1728.). However, investigation has confirmed these are partial payments made for a single encounter or procedure. Because coding varies by station, users are encouraged to employ multiple variables in an effort to find all care associated with a particular setting or service type. Accessed October 16, 2015. There is another category of Fee Basis care that is considered unauthorized care. VENDID is the vendor ID. There is limited information on the providers associated with Fee Basis care. [SpatientAddress] tables. Institutional Aspects of the Non-VA Medical Care System, https://www.va.gov/health-care/get-reimbursed-for-travel-pay/, http://www.va.gov/opa/choiceact/documents/Choice-Program-Fact-Sheet-Final.pdf. The Fee Card (VET) file contains only summary payment figures by month, although researchers can match the records to other data by SCRSSN and other identifiers. Prescription-related data in the PHARVEN file contain only summary payments by month. Office of Information and Analytics. There are also a number of other financial variables denoted in SAS (see Table 7). This schema contains sensitive information such as SSNs, bank accounts, and the actual name of personnel. PatientIEN and PatientSID are unique to a patient within a facility, but not unique to a patient across VA facilities (e.g., a patient who had visited multiple VA facilities will have multiple PatientIENs and multiple PatientSIDs). For example, if the Veteran had an Emergency Department (ED) visit and then was admitted to the hospital, this would be considered inpatient care. U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. It is also possible that researchers will find a slight difference in the observations that the SAS versus SQL data contain. Veterans should mail or fax correspondence pertaining to compensation claims to the below location. expectation of privacy in the use of Government networks or systems. In SAS, data are stored in variables, observations and datasets. VA regulations 38 CFR 17.1000-17.1008. Please contact the referring VAMC for e-fax number. The Act amends 38 U.S.C. Many veterans now have access to Non-VA medical care through the new Veterans Access, Choice, and Accountability Act (VACAA, or Choice Act). YESThis insurance is also known as: Veterans Administration. There is also a host of non-emergency surgery provided through Fee Basis mechanisms that may be of interest to researchers. A record is created only if there is a code on the invoice to be recorded. VSSC provides numerous relevant web reports, data resources, and analytics support, including summary data by facility and VISN and national summary data. The 2 sets of DRGs are not interchangeable. There are nine situations in which Non-VA Medical Care is authorized. Veterans Access, Choice, And Accountability Act of 2014: Title I: Choice Program and Health Care Collaboration [online]. Note that the vendor may represent the hospital, a hospital chain or the entity billing on behalf of the provider. For example, to understand the ICD-9 codes associated with a particular inpatient encounter, one would have to link the [Fee]. Hit enter to expand a main menu option (Health, Benefits, etc). This technology integrates with Veterans Information Systems and Technology Architecture (VistA) through Massachusetts General Hospital Utility Multi-Programming System (MUMPS) or a Structured Query Language (SQL) database system on the backend. Unauthorized inpatient or outpatient claims must be submitted within 90 days from the date of care. VA will not pay merely a deductible, copayment, or COB (coordination of benefits) amount. Reimbursements appear in the Travel Expenses (TVL) file. Hit enter to expand a main menu option (Health, Benefits, etc). See the FBCS page (CDW Raw) on the CDW SharePoint site (VA intranet only: https://vaww.cdw.va.gov/bisl/Database/SitePages/Raw%20Extractor.aspx) for more information. This can become complicated by the fact that not all encounters relating to the same inpatient stay will have the same admission and discharge dates. The vendor no longer supports VA installations of this technology. Defining a cohort is an activity that is different for each project and depends on the research question at hand. After a claim is submitted electronically it must be entered manually into a Non-VA Medical Care approval system. 8. 21. VA employees working on operations studies can build their own crosswalk file as they have permission to use these file. DART is a workflow application that guides users through the request by collecting the appropriate documents, distributing documentation to reviewers, and assisting in communication between requestors and reviewers. Before working with any SQL tables in CDW, we recommended familiarizing yourself with the schema diagram in order to understand how to link tables to one another. There are often multiple observations per inpatient stay and multiple observations per outpatient encounter. Call: 988 (Press 1), U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. Veterans Choice Program - Fee Basis Claims System in CDW - Veterans Affairs Note: Admission date is only relevant for inpatient stays; it is not relevant for outpatient visits. [FeePrescription] tables. Researchers must consider whether a missing value means not applicable. For example, many inpatient (INPT) records lack a value for any of the surgery codes (SURG9CD1-SURG9CD5). To evaluate the time it takes VA to process Fee Basis claims, we evaluated SAS data for FY2014. Fee Basis data will be most useful for studying conditions where contract care is common, such as home-based care and nursing care, and for determining typical non-VA charges for health care services (both charges and payments are reported) and comparing those to VA costs. Health - Veterans Affairs Training - Exposure - Experience (TEE) Tournament, Observational Medical Outcomes Partnership (OMOP), Personnel & Accounting Integrated System (PAID), Decision Analysis: Decision Trees, Simulation Models, Sensitivity Analyses, Measuring the Cost of a Program or Practice: Microcosting, List of VA Economists and Researchers with Health Economic Interests, 7. Electronic 837 claim and 275 supporting documentation submissions can be completed through VAs contracted clearinghouse, Change Healthcare, or through another clearinghouse of your choice. [FeeInpatInvoice] table, one must first link that table to the [Fee]. Persons looking to classify patients Veterans by race and ethnicity are encouraged to read VHA guidance available on the Data Reports page of the VHA Data Portal (available on the intranet at http://vaww.vhadataportal.med.va.gov/Resources/DataReports.aspx). Most of these fields would be empty. Race and ethnicity are found in the [PatientEthnicity], [PatSub]. 1-800-273-8255 (Press 1), U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. Thus, one could not simply use the patient identifier and the admission and discharge dates to collapse these observations into one inpatient stay. The SAS files also include a patient type variable (PATTYPE). Florida Department of Veterans' Affairs | Connecting veterans to Under this regulation, ambulances will be reimbursed at the lesser of (a) the amount the Veteran is personally liable or (b) 70 percent of the applicable Medicare Ambulance Fee Schedule. HIPAA Transaction Standard Companion Guide (275 TR3)The purpose of this companion guide is to assist in development and deployment of applications transmitting health care claim attachments intending to support health care claim payment and processing by VA community care health care programs. Office of Information and Analytics. Facility Information Security Officers (ISOs) are often the CUPS POC. Training - Exposure - Experience (TEE) Tournament, Observational Medical Outcomes Partnership (OMOP), Personnel & Accounting Integrated System (PAID), Decision Analysis: Decision Trees, Simulation Models, Sensitivity Analyses, Measuring the Cost of a Program or Practice: Microcosting, List of VA Economists and Researchers with Health Economic Interests.
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